Childhood obesity is an increasing problem, but when does it constitute grounds for a charge of neglect? Russell Viner and colleagues review the evidence and propose a framework for practice

The suggestion that childhood obesity may raise child protection concerns has generated increasing media and professional interest.123 The British Medical Association annual meeting in 2007 rejected a motion suggesting that childhood obesity in under 12s should result in legal protection for the child and parents being charged with neglect.4 However, a BBC survey of 50 consultant paediatricians that month reported that obesity had been a factor in at least 20 child protection cases in the previous year.3 In October 2008, the UK Local Government Association warned that increasing child protection actions related to childhood obesity would be a future cost pressure for local councils.5 Similar concerns are evident internationally,67 with case reports of US courts acting to remove obese children from their parents.8

Most recently, UK researchers reported that four out of the five obese children in their study identified with an extremely rare genetic deletion associated with overeating had also been on child protection registers.9 This was widely reported as evidence that families of obese children were being unfairly accused of abuse.1011 Despite the high degree of contention, there are few published data and no published guidelines for professionals.

Why is there a problem?

The rising epidemic of childhood obesity is caused by a long term positive energy balance in modern children. This is related to a host of lifestyle factors affecting both energy intake (type and energy density of food, access to healthy foods, speed of consumption, family eating, meal behaviours, etc) and energy expenditure (activity, sedentary behaviours, safety concerns, and access).12 It is therefore not surprising that parents and …